- Dislocation + Coronoid Process Frx: Classification;
- frx is due to avulsion by brachialis when elbow is hyperextened;
- type I: avulsion of the tip of the coronoid process;
- type II: involving less than 50% of the process
- for above types closed reduction and early motion is recommended;
- fixation of frx fragments may not guarantee stability;
- consider external fixation distraction device;
- type III: frag involving > 50% of process
- almost always associatted w/ posterior dislocation;
- assoc w/ high redislocation rate & requires ORIF
- there will be assoc valgus instability since MCL inserts onto the fracture fragment;
- if frx pattern is not amenable to rigid fixation, is an indication for an external fixation distraction device;
- left untreated, the worst of all scenarios may develop: ie, an unstable eblow joint which is also stiff and painful;
- Closkey, et al: elbows of cadavera tested before and after fracture of the coronoid process to assess the stabilizing
contribution of coronoid;
- there was no significant difference, at any flexion position, in posterior axial displacement between the intact elbows
and the elbows in which 50 percent or less of the coronoid process was fractured (type I and type II) (p = 0.43);
- significant differences, across all flexion positions, in posterior axial displacement between the intact elbows
and elbows in which more than 50 percent of coronoid process was fractured (type III) (p = 0.006);
- in response to axial load, elbows with a fracture involving more than 50 percent of the coronoid process displace more
readily than elbows with a fracture involving 50 percent or less of the coronoid process, especially when the elbow
is flexed 60 degrees and beyond;
- reference: Coronoid fracture patterns. - surgical approach: - w/ associated radial head fracture: consider lateralapproach to the coronoid fracture;
- w/ isolatedcoronal fracture: consider medial or anterior approach;
- anterior approach:
- medial approach:
- if the radial head was not excised, the coronoid is approached medially;
- ref: Medial Elbow Exposure for Coronoid Fractures: FCU-Split Versus Over-the-Top.
- fixation technque:
- ulnar nerve is transposed anteriorly;
- FCU heads are split and the anterior head is retracted anteriorly;
- cannulated screw fixation:
- ACL tibial guide is used to guide a K wire thru the posterior olecranon and up into the coronoid region;

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Orthopaedics and the US Military

Text Author

Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital.